Journal Information
Vol. 58. Issue 6.
Pages 562-567 (01 June 2003)
Share
Share
Download PDF
More article options
Vol. 58. Issue 6.
Pages 562-567 (01 June 2003)
DOI: 10.1016/S1695-4033(03)78122-3
Full text access
Trombocitopenia aloinmune en el feto y en el recién nacido
Fetal-neonatal alloimmune thrombocytopenia
Visits
...
E. Muñiz-Díaza,
Corresponding author
emuniz@hsp.santpau.es

Correspondencia: Banco de Sangre. Hospital de Sant Pau.Avda. Sant Antoni M.ª Claret, 167. 08025 Barcelona. España.
, G. Ginovart Galianab
a Banco de Sangre. Departamento de Hematología.
b Servicio de Pediatría. Hospital Sant Pau-Creu Roja.Universidad Autónoma de Barcelona. España.
Article information
Abstract
Bibliography
Download PDF
Statistics

La trombocitopenia fetal/neonatal aloinmune se considera en la actualidad la causa más común de trombocitopenia grave en el recién nacido. Se produce por la acción de un aloanticuerpo plaquetario específico materno que reacciona con un antígeno de las plaquetas fetales/neonatales heredado del padre que conduce a la destrucción de éstas. Como consecuencia de la citopenia puede producirse una hemorragia cerebral (10-30% de los neonatos) con resultado de muerte (10 % de los casos comunicados) o de secuelas neurológicas irreversibles (20 %). En la mayoría de casos se detecta al observar en el neonato una diátesis hemorrágica cuyo grado de gravedad varía en función de la cifra de plaquetas. Las técnicas actuales de investigación de aloanticuerpos plaquetarios permiten la detección del aloanticuerpo plaquetario (anti-HPA-1a) responsable en la mayoría de los casos, lo cual, unido al diagnóstico clínico y a la exclusión de otras causas de trombocitopenia neonatal constituyen la base para realizar un diagnóstico correcto. El riesgo de aparición de hemorragia cerebral en futuras gestaciones obliga a efectuar un programa profiláctico antenatal cuyo contenido todavía no ha sido totalmente consensuado. El diagnóstico precoz de este proceso puede permitir administrar un tratamiento eficaz basado en la transfusión de plaquetas de fenotipo compatible, o de inmunoglobulinas intravenosas cuando no existen manifestaciones hemorrágicas graves. La profilaxis en futuras gestaciones puede evitar la recurrencia de la trombocitopenia y la aparición de un nuevo episodio de hemorragia cerebral. La finalidad de esta revisión es llamar la atención sobre un proceso que todavía hoy probablemente es infradiagnosticado en nuestro medio, y cuyo diagnóstico precoz puede evitar la aparición de complicaciones potencialmente muy graves.

Palabras clave:
Trombocitopenia aloinmune

Fetal-neonatal alloimmune thrombocytopenia is the commonest cause of severe thrombocytopenia in the newborn. This disorder is due to the destruction of fetal platelets by a maternal platelet-specific antibody caused by fetal-maternal incompatibility. The most serious complication is intracranial hemorrhage (10-30% of newborns), which may cause death (10 % of the reported cases) or irreversible neurological sequelae (20 %). The diagnosis is usually made after birth when most affected neonates have petechiae, purpura or overt bleeding. The degree of severity varies according to platelet count. Current methods allow detection of maternal platelet alloantibodies (usually HPA-1a). Clinical grounds and the exclusion of other causes of neonatal thrombocytopenia are required to establish an accurate diagnosis. Recurrence of this disease is very high and has prompted clinicians to develop antenatal prophylactic programs in subsequent pregnancies. However, the optimal treatment of at-risk pregnancies remains controversial. The early diagnosis of this process allows effective therapy based on the infusion of compatible platelets and IgG immunoglobulins when hemorrhage is not obvious. Antenatal management of subsequent pregnancies can prevent recurrence of thrombocytopenia and intracranial hemorrhage. The aim of this review is to draw pediatricians’ attention to the importance of this probably under-diagnosed disease in which early diagnosis can prevent potentially severe complications.

Keywords:
Alloimmune thrombocytopenia
Full text is only aviable in PDF
Bibliografía
[1.]
C. Kaplan.
Immune thrombocytopenia in the foetus and the newborn:Diagnosis and therapy.
Transfus Clin Biol, 8 (2001), pp. 311-314
[2.]
L.M. William som, G. Hackett, J. Rennie, C.h. Palmer, C. Maciver, R. Hadfield, et al.
The natural history of fetomaternal alloimmunization to the platelet-specific antigen HPA-1a (PlA1, Zwa) as determined by antenatal screening.
Blood, 92 (1998), pp. 2280-2287
[3.]
M. Dreyfus, C. Kaplan, E. Verdy, N. Schlegel, I. Duran-Zaleski, G. Tchernia, et al.
Frequency of iimune thrombocytopenia in newborns:A prospective study.
Blood, 89 (1997), pp. 4402-4406
[4.]
M.F. Murphy, H. Hambley, K. Nicolaides, A.H. Waters.
Severe feto-maternal alloimmune thrombocytopenia presenting with fetal hydrocephalus.
Prenatal Diagnos, 16 (1996), pp. 1152-1155
[5.]
S.J. Stanworth, G.A. Hackett, L.M. Williamsom.
Fetomaternal alloimmune thrombocytoepnia presenting antenatally as hydrops fetalis.
Prenatal Diagnos, 21 (2001), pp. 423-424
[6.]
C. Kaplan, F. Daffos, F. Forestier, M.C. Morel, N. Chesnel, G. Tchernia.
Current trends in neonatal alloimmune thrombocytopenia:Diagnosis and therapy.
Platelet immunology:Fundamental and clinical aspects, pp. 267-278
[7.]
A.E.G.K. Vondem Borne, F. Décary.
Nomenclature of platelet-specific antigens.
Transfusion, 30 (1990), pp. 477
[8.]
S. Santoso, V. Kiefel, et al.
Human platelet alloantigens: Update.
Vox Sang, 74 (1998), pp. 249-253
[9.]
G.F. Lucas, P. Metcalfe.
Platelet and granulocyte glycoprotein-polymorphisms.
Transf Med, 10 (2000), pp. 157-174
[10.]
J.G. Kelton, J.W. Smith, P. Horsewood, J.R. Humbert, C.P. Hayward, T.E. Warkentin.
Gova/b alloantigen system on human platelets.
Blood, 75 (1990), pp. 2172-2176
[11.]
C. Mueller-Eckhardt, A. Grubert, M. Weisheit, G. Mueller-Eckhardt, V. Kiefel, H. Kroll, et al.
348 cases of suspected neonatal alloimmune thrombocytopenia.
Lancet, 333 (1989), pp. 363-366
[12.]
E. Muñiz-Díaz, P. Madoz, A. Ribera, T. Pérez Castellanos, B. Pérez de Mendiguren, M. Arilla, et al.
Trombocitopenia neonatal aloimmune por anticuerpos de especificidad Bri* Descripción de los primeros casos detectados con la técnica de MAIPA.
Biol Clin Hematol, 13 (1991), pp. 181-189
[13.]
C. Kaplan, M.C. Morel-Kopp, H. Kroll, V. Kiefel, N. Schlegel, N. Chesnel, et al.
HPA-5b(Bra) neonatal alloimmune thrombocytopenia:Clinical and immunological analysis of 39 cases.
Br J Haematol, 78 (1991), pp. 425-429
[14.]
J. Glade-B ender, J. McFarland, C. Kaplan, L. Porcelijn, J. Bussel.
Anti-HPA3 a induces severe neonatal alloimmune thrombocytopenia.
J Pediatr, 138 (2001), pp. 862-867
[15.]
Y. Shibata, I. Matsuda, T. Miyaji, Y. Ichikawa.
Yuk.a, a new platelet antigen involved in two cases of neonatal alloimmune thrombocytopenia.
Vox Sang, 50 (1986), pp. 177-180
[16.]
M.C. Morel- Kopp, B. Blanchard, V. Kiefel, J. Joly, C. Mueller-Eckardt, C. Kaplan.
Anti-HPA-4b (Yuk.a) neonatal alloimmune thrombocytopenia. First report in a Caucasian family.
Transf Med, 2 (1992), pp. 273-276
[17.]
N. Puig, E. Muñiz Díaz, E. Monteagudo, A. Ribera, J.A. Montoro.
Second case of neonatal alloimmune thrombocytopenia by anti-HPA-4b (anti-Yuk.a) in a Caucasian family.
Transf Med, 3 (1993), pp. 164-165
[18.]
C. Martínez, E. Muñiz-Díaz, N. Puig, M. Ibáñez, M. Gracia, M. Arilla, et al.
Neonatal alloimmune thrombocytopenia is still an immune diagnosis challenge.
Transf Med, 8 (1998), pp. 87
[19.]
R. Parra, P. Pérez-Anoro, J. Gil, G. Gala, R. Calzada, D. Gallardo, et al.
Neonatal alloimmune thrombocytopenia:immunological profile in 92 cases).
Transf Med, 68 (1998), pp. 88
[20.]
J.O. Bordin, J.G. Kelton, M.N. Warner, J.W. Smith, G.A. Denomme, T.E. Warkentin, et al.
Maternal immunization of the Gov alloantigen system on human platelets.
Transfusion, 37 (1997), pp. 823-828
[21.]
J. Berry, C.M. Murphy, G.A. Smith, E. Ranasinghe, R. Finberg, J. Walton, et al.
Detection of Gov system antibodies by MAIPA reveals an immunogenicity similar to the HPA-5 alloantigens.
Br J Haematol, 110 (2000), pp. 735-742
[22.]
D. L'Abbé, l. Tremblay, M. Goldman, F. Décary, P. C hartrand.
A lloimmunization to platelet antigen HPA-1a (P1A1): association with HLA-DRw52 is not a 100%.
Transf Mef, 2 (1992), pp. 251-253
[23.]
M.F. Murphy, L.M. Williamson.
Antenatal screening for fetomaternal alloimmune thrombocytopenia:An evaluation using criteria of the U.K national screening committee.
Br J Haematol, 111 (2000), pp. 726-732
[24.]
A.E.G.K. Von dem Borne, F.W.A. Verheugt, F. Oosterhof, E. Von Riesz, A. Brutel de la Rivière, C.P. Engelfriet.
A simple immunofluorescence test for the detection of platelet antibodies.
Br J Haematol, 39 (1978), pp. 195-207
[25.]
V. Kiefel, S. Santoso, M. Weisheit, C.M. Mueeler-Eckhardt.
Monoclonal antibody-specific immobilization of platelet antigens (MAIPA):A new tool for the identification of platelet reactive antibodies.
Blood, 70 (1987), pp. 1722-1726
[26.]
G.F. Lucas, S.E. Rogers.
Evaluation of an enzyme-linked immuno-sorbent assay (GTI PakPlus) for the detection of antibodies against human platelet antigens.
Transf Med, 9 (1999), pp. 63-67
[27.]
H. Kroll, V. Kiefel, S. Santodo, et al.
Clinical aspects and typing of platelet alloantigens.
Vox Sang, 74(Suppl 2) (1998), pp. 345-354
[28.]
H. Ouwehand, G. Smith, E. Ranasinghe.
Management of severe alloimmune thrombocytopenia in the newborn.
Arch Dis Child Fetal Neonatal Ed, 83 (2000), pp. F173-F175
[29.]
E. Ranasinghe, J.D. Walton, C.M. Hurd, L. Saul, G. Smith, K. Campbell, et al.
Provision of platelet support for fetuses and neonates affected by severe fetomaternal alloimmune thrombocytopenia.
Br J Haematol, 113 (2001), pp. 40-42
[30.]
M.F. Murphy, C. Knechtli, C. Downie, S.E. Rogers, G.F. Lucas.
Seren-depity and the use of random platelets in fetomaternal alloimmune thrombocytopenia (FMAIT).
Br J Haematol, 113 (2001), pp. 1077-1078
[31.]
E. Muñiz-Díaz, J. Parra, G. Ginovart, C. Martínez, M. Ibáñez, M. Gracia, et al.
Tratamiento antenatal de la trombocitopenia fetal/neonatal aloinmune con transfusión de plaquetas intra-útero.
Haematologica, 86(Supl 2) (2001), pp. 1
[32.]
C. Kaplan, F. Daffos, F. Forestier, W.L. Cox, D. Lyon-Caen, M.C. Dupuy-Montbrun, et al.
Management of alloimmune throm-bocytoepnia:antenatal diagnosis and in utero transfusion of maternal platelets.
Blood, 72 (1988), pp. 340-343
[33.]
M.F. Murphy, A.H. Waters, H.A. Doughty, H. Hambley, R.S. Mibashan, K.H. Nicolaides, et al.
Antenatal management of fetomater-nal alloimmune thrombocytopenia-report of 15 affected pregnancies.
Transfus Med, 4 (1994), pp. 281-292
[34.]
J.B. Bussel, R.L. Berkowitz, J.G. McFarland, L. Lynch, U. Chitkara.
Antenatal treatment of neonatal alloimmune thrombocytopenia.
N Engl J Med, 319 (1988), pp. 1374-1378
[35.]
J.B. Bussel, R.L. Berkowitz, L. Lynch, M.L. Lesser, M.J. Paidas, C.L. Huang, et al.
Antenatal management of alloimmune thrombocyto-penia with intravenous gammaglobulin:A randomized trial of the addition of low dose sterorid to IVIg in fifity-five maternal-fetal pairs.
Am J Obstet Gynecol, 174 (1996), pp. 1414-1423
[36.]
H. Kroll, V. Kiefel, G. Giers, R. Bald, J. Hoch, P. Hanfland, et al.
Maternal intravenous immunoglobulin treatment does not prevent intracranial hemorrhage in fetal alloimmune thrombocytopenia.
Transfus Med, 4 (1994), pp. 293-296
[37.]
C. Kaplan, M.F. Murphy, H. Kroll, A.H. Waters.
Feto-maternal alloimmune thrombocytopenia:Antenatal therapy with IvIgG and steroids-more questions than answers.
Br J Haematol, 100 (1998), pp. 62-65
[38.]
R. Zimmerman, A. Huch.
In utero fetal therapy with immuno-globulin for alloimmune thrombocytopenia.
Lancet, 340 (1992), pp. 606
[39.]
H.A. Doughty, M.F. Murphy, P. Metcalfe, A.H. Waters.
Antenatal screening for fetal alloimmune thrombocytopenia:The results of a pilot study.
Br J Haematol, 90 (1995), pp. 321-325
Copyright © 2003. Asociación Española de Pediatría
Idiomas
Anales de Pediatría (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.